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acute uric acid nephropathy
Etiology:
1) tumor lysis syndrome after chemotherapy
2) myeloproliferative disorders
3) heat stroke
4) status epilepticus
5) Lesch-Nyhan syndrome
Pathology:
1) intraluminal crystals cause intrarenal obstruction
2) concurrent hypertension, ischemia or poorly-controlled diabetes accompany tubulointerstitial damage in patients with hyperuricemia
Laboratory:
1) serum uric acid often > 15 mg/dL
2) 24 hour urine uric acid > 1 gram
3) spot urine uric acid/creatinine is often > 1.0
Differential diagnosis:
1) lead nephropathy
2) de novo gout in renal failure is rare
- patient has lead nephropathy until proven otherwise
Management:
1) prevention:
a) alkaline diuresis
b) allopurinol
2) treatment: dialysis
3) prognosis: condition is generally reversible
Related
hyperuricemia
hyperuricosuria
urate; uric acid
General
acute interstitial nephritis
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 613
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998